Analysis of thirteen cases with hyperthyroidism-associated myocardial infarction

Background The close relationship between the thyrotoxic state and abnormalities in cardiac function,arrhythmias and congestive heart failure is well known to clinicians. Patients with hyperthyroidism-induced acute myocardial infarction(AMI) are unusual and almost all reported cases have been associated with coronary vasospasm. There is quite consistent evidence that hyperthyroidism is directly associated with the presence of a prothrombotic state. Methods The present article reports a 69-year-old female with hyperthyroidism who developed myocardial infarction(MI) and reviews AMI in hyperthyroidism cases reported in the literature. We conducted a comprehensive review of the English literature since 1990 to analyze data on MI in hyperthyroidism patients who had developed AMI. Results From 11 English articles, we identified 12 hyperthyroidism patients, plus our cases, with AMI. They consisted of 11 females and 2 males.Their mean age was 49 ± 14.4 years(range 28-71). Coronary angiography revealed normal coronary arteries in 6 patients, coronary spasm in 6 patients. Only our patient received percutaneous coronary intervention through coronary thrombus suction and other patients were treated mainly with medicine. Twelve patients had good prognosis and 1 patient died of cardiogenic shock. Conclusions Hyperthyroidism-induced AMI is rare.Coronary thrombus or spasm without coronary atherosclerotic stenosis should be considered. Different therapies should be chosen according to different types of coronary involvement.     

二甲双胍对TNF-α诱导的血管平滑肌细胞迁移的影响及其机制

【】目的：观察二甲双胍对TNF-α诱导的血管平滑肌细胞迁移的影响并探讨其可能的分子机制。方法：将TNF-α作用于血管平滑肌细胞,并用二甲双胍进行干预。实验设对照组(control)、TNF-α组(TNF-α)、二甲双胍 TNF-α组(Metformin TNF-α)、二甲双胍组(Metformin)。分别用划痕实验和Transwell实验检测细胞的迁移能力;ELISA检测MMP-2、MMP-9的分泌;RT-PCR检测MMP-2、MMP-9 mRNA的表达;Western blot检测MMP-2、MMP-9以及各组细胞核内NF-kB、胞浆IkB的表达。结果：划痕实验和Transwell实验均显示TNF-α组细胞迁移能力显著高于对照组(P<0.01),Metformin组细胞迁移能力显著低于对照组(P<0.05),Metformin TNF-α组细胞迁移能力低于TNF-α组(P<0.01); TNF-α组MMP-2、MMP-9、NF-kB的表达显著高于对照组,IkB的表达则降低(P<0.01)。Metformin TNF-α组较TNF-α组MMP-2、MMP-9、NF-kB的表达则显著下降,IkB的表达则升高(P<0.01)。Metformin组细胞内MMP-2、MMP-9的表达与对照组比较有显著差异(P<0.05),但上清中MMP-2、MMP-9的含量以及细胞内NF-kB、IkB蛋白的表达与对照组相比并无显著差异(P>0.05)。结论：二甲双胍能抑制TNF-α诱导的血管平滑肌细胞迁移,其抑制作用与MMPs表达量的下调及NF-kB信号通路的阻断有关。